Monotherapy as Efficient as Twin Remedy for Methicillin-Resistant Staphylococcus aureus

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Sufferers who had been switched from twin remedy to monotherapy for the therapy of methicillin-resistant Staphylococcus aureus (MRSA) didn’t differ for composite 60-day medical outcomes in contrast with sufferers present process mixture remedy. These findings from a retrospective cohort research had been revealed in Open Discussion board Infectious Ailments.

Sufferers (N=140) admitted to the Ohio State College Wexner Medical Middle with index MRSA between 2011 and 2019 had been retrospectively assessed for 60-day medical outcomes. All sufferers acquired twin remedy of ceftaroline and daptomycin for not less than 72 hours. Sufferers who had been maintained on twin remedy for not less than 10 days had been assigned to the mixture cohort (n=66), and sufferers who had been switched to monotherapy had been assigned to the monotherapy cohort (n=74).

The monotherapies included daptomycin (n=30), vancomycin (n=26), and ceftaroline (n=18).


Proceed Studying

Sufferers within the mixture and monotherapy cohorts had been 53% and 49% girls, had a median age of 42 (interquartile vary [IQR], 32-55) and 50.5 (IQR, 37-63) years, and 74% and 81% had been White, respectively. The mix cohort included extra sufferers with a historical past of intravenous drug use (58% vs 36%; P =.01) and fewer sufferers with power kidney illness (18% vs 38%; P =.01) or diabetes mellitus (17% vs 38%; P =.005).

The composite consequence of 60-day recurrence, readmission, or infection-related mortality occurred amongst 21% of the mixture and 24% of the monotherapy teams (P =.66). The charges of MRSA recurrence (3% vs 7%; P =.45), readmission (20% vs 18%; P =.75), and infection-related mortality (2% vs 5%; P =1) didn’t differ considerably for the mixture and monotherapy cohorts, respectively.

The median inpatient keep for sufferers receiving twin remedy was 26 (IQR, 20-41) days and for these receiving monotherapy was 24.5 (IQR, 16-33) days (P =.08).

A complete of three sufferers had hostile reactions: 1 had bone marrow suppression, 1 had neutropenia, and 1 had pedal edema. Charges of those occasions didn’t differ on the premise of therapy (P =.47).

Amongst solely sufferers who developed endocarditis, epidural abscess, or osteomyelitis (mixture: n=50; monotherapy: n=41), the speed of the composite consequence was 26% and 17% (P =.31) for the combinatorial and monotherapy cohorts, respectively.

This research was restricted by its small pattern measurement and single-center, retrospective design.

These knowledge indicated the composite 60-day consequence of recurrence, readmission, and mortality was not considerably totally different for sufferers who had been maintained on the twin remedy of ceftaroline and daptomycin vs these for whom therapy was de-escalated to a monotherapy of daptomycin, vancomycin, or ceftaroline. This sample was related amongst sufferers who developed endocarditis, epidural abscess, or osteomyelitis.

Reference

Nichols CN, Wardlow LC, Coe KE, Sobhanie MME. Scientific outcomes with definitive therapy of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with retained daptomycin and ceftaroline mixture remedy versus de-escalation to monotherapy with vancomycin, daptomycin, or ceftaroline. Open Discussion board Infect Dis. 2021;ofab327. doi:10.1093/ofid/ofab327



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